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Guides through decision to have surgery to treat chronic sinusitis. Discusses endoscopic and traditional surgery. Explains who is a good candidate for surgery. Lists reasons for and against surgery. Includes interactive tool to help you make your decision.

Sinusitis: Should I Have Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Your options

Key points to remember

Very few people need surgery for sinusitis. Most people can
treat the problem with home care and medicines.

Surgery may be a good choice for people who have long-term
(chronic) sinusitis. They may get one infection after another because something
blocks the flow of mucus from the sinuses or because of another health problem.
Surgery can remove blockages and make the sinus openings bigger. This helps the
sinuses drain, preventing more infections.

To be sure that surgery is a good choice, you need to have a
CT scan of your sinuses. This test will be done after
you have followed what's called "maximum medical treatment" for 4 to 6 weeks.
This means that you take medicines and follow home treatment to reduce
infection and swelling. That helps your doctor see what's causing your
infections.

You may need more than one surgery to fix your sinuses.

After surgery, you still may need to take medicines, such as
antibiotics, and follow home treatment for a long time.

If you
get chronic sinusitis because of
allergies or another problem, you need to get that
problem under control before you have surgery. You will have better results
from surgery if you use medicine and home treatment after surgery to help to
keep that problem under control.

When a mucous membrane gets
inflamed, it swells. This can block the normal flow of fluid from the sinuses
into the nose and throat. Bacteria and fungi (plural of fungus) are more likely
to grow and cause an infection in sinuses that can't drain.

The
main cause of sinusitis is a viral infection, usually a cold. Allergies or
other problems also can block the nasal passages and lead to sinusitis.

There are two types of sinusitis: acute (short-term) and chronic
(long-term). You may have chronic sinusitis if:

You have had more than three sinus infections
in 1 year that needed antibiotics to clear up, OR

You have had a sinus infection for more than 12
weeks that
antibiotics have not cleared up.

Surgery may be a good choice for some people who have
chronic sinusitis.

Endoscopic surgery is the type
that is done most often. The doctor puts a thin, lighted tool called an
endoscope in the nose to remove small amounts of bone or tissue that block the
sinus openings. The doctor also can remove polyps.

Traditional surgery may be done
for certain serious problems—such as pus in a sinus, infection of the facial
bones, or a brain
abscess. The doctor makes an opening into the sinus
from inside the mouth or through the skin of the face.

Sometimes another problem inside the nose (such as a
deviated septum) also needs to be fixed. This may be done during the same
surgery.

Very few
people need surgery to treat sinusitis. But you may need surgery if
ALL of these are true:

Your doctor says that you have chronic
sinusitis.

You've followed what's called "maximum medical
treatment" for 4 to 6 weeks. This means that you've taken medicines and
followed home treatment for at least 4 to 6 weeks. This treatment includes
antibiotics, a
steroid nasal spray, and other prescription
medicines.

You've had a
CT scan of your sinuses after the 4 to 6 weeks of
treatment. It is very important to have the CT scan done after this treatment. Reducing the swelling and infection as
much as possible lets your doctor see what could be causing your
infections.

The CT scan shows that something, such as nasal polyps, is keeping your
sinuses from draining as they should.

You also may need surgery if:

You have a sinus infection caused by a
fungus. Infections caused by fungi cannot be cleared up with
antibiotics.

You have a serious problem such as an infection that
spreads beyond your sinuses. This is rare.

Most of the time, you can treat your sinus problem with home care and
medicines.

Home treatment

Drink plenty of fluids
to help keep the
mucus thin.

Hold a warm, damp towel or a warm gel pack to your face for 5 to 10 minutes several
times a day.

Breathe warm, moist air from a
steamy shower, a hot bath, or a sink filled with hot water. Avoid very cool,
dry air. A humidifier can add moisture to the air in your
home.

Use saltwater nasal drops or washes to help
keep your nasal passages open and to wash out mucus and bacteria. You can buy
saline nose drops or saline nasal washes (such as a Neti Pot) at a drugstore or grocery store, or you can make your
own at home. People around age 8 and older may also find it helpful to gargle often with warm salt water.

If you need to blow your nose, do it gently. Blowing your nose too hard may
force thick mucus back into your sinuses. Keep both nostrils open when you blow
your nose.

Medicines

Take pain relievers, such as
acetaminophen or ibuprofen, that you can buy without a prescription.

Use a steroid nasal spray or decongestant nasal sprays or pills to reduce the swelling of the mucous membranes. If you use a nasal spray, do not use it longer than what the label says.

Take antibiotics as directed, if your doctor prescribes them.
Antibiotics can treat most short-term (acute) sinusitis when it is caused by
bacteria.

Use mucolytics (such as guaifenesin) to thin the mucus in your sinuses.

Be safe with medicines. Read and follow all instructions on the label. Some medicines may not be safe for young children or for people who have certain health problems.

Serious but rare risks can include heavy bleeding,
meningitis, and brain injury. But these happen in less
than 1 out of 100 sinus surgeries. That means they don't happen more than 99 times
out of 100.2

Surgery might not work. About
10 out of 100 people find that it doesn't help.1

You could need to have another surgery.

Use home care for
sinusitis Use home care for
sinusitis

You take
antibiotics for a bacterial infection.

You use
steroid nasal sprays,
decongestants, and
over-the-counter pain medicines.

You do
other self-care, such as washing your nasal passages with saline, putting a
warm cloth on your face, and blowing your nose gently.

Home care may get rid of your sinus
infections.

Antibiotics are effective for bacterial infections.

You don't have the risks of surgery.

You don't have
the pain of surgery or need to deal with follow-up care.

You can decide later to have surgery if home care doesn't help
you enough.

Home care might not get
rid of your sinus problem.

Antibiotics don't work for viral infections and don't work for all types of bacterial infections.

It won't fix certain serious problems, such as an infection in
the bones of your face or a brain
abscess.

Antibiotics can cause side
effects, which may include
allergic reaction, nausea, and
diarrhea.

Steroid nasal sprays can cause side effects, which may
include a burning feeling in the nose and nosebleeds.

Spray
decongestants can make congestion worse if you use them more times in one day or more days than the label says.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about choosing surgery for sinusitis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I have had
one sinus infection after another for the better part of a year. I've been
taking antibiotics and using steroids and decongestant nasal sprays for a month
now with no results. My doctor just did a CT scan and found out that one of my
sinuses is blocked. He says he can fix it with surgery.

Pete, age 43

I've had a couple of bouts of sinusitis
this year, so I asked my doctor about sinus surgery. She said there are some
stronger antibiotics and other treatments I should try. I agree that it's
better to try the medicines.

Misti, age 32

My doctor
fired all the medicines at this infection that she could, and I took them just
the way she told me to, but nothing seemed to work. After she looked at my CT
scan, my doctor thinks what I've got may be a fungal infection. That would
explain why the antibiotics I've tried haven't helped. I hate the idea of
having the surgery, but I have tried everything else.

Marona, age 54

I have
pretty bad sinusitis, and I've had it a few times over the years. The last time
I got it, my doctor prescribed antibiotics and showed me how to wash out my
sinuses with salt water, and that worked. I'm going to try that again, and my
doctor says there are some other things we can try, too, like nasal sprays and
allergy medicines.

Jonathan, age 29

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have sinus surgery

Reasons to use home treatment

I want to do everything I can to stop my sinus infections.

I want to avoid surgery if at all possible.

More important

Equally important

More important

I'm not afraid of the risks of surgery.

I don't want to take any chance on problems from surgery.

More important

Equally important

More important

The pain and pressure in my sinuses is making me miserable.

I can control the pain and pressure with medicines.

More important

Equally important

More important

I'm tired of not breathing well.

I can still breathe well.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surgery

Home treatment

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Do most people need surgery to treat sinusitis?

YesSorry, that's not right. Very few people need surgery. Medicines and home care usually are enough.

NoThat's right. Very few people need surgery. Medicines and home care usually are enough.

I'm not sureIt may help to go back and read "Get the Facts." Very few people need surgery. Medicines and home care usually are enough.

2.

Do you need to try several weeks of medicines and other treatment before you and you doctor decide about surgery?

YesThat's right. You need to follow your doctor's plan of medicine and other treatment for 4 to 6 weeks. This treatment can reduce swelling so your doctor can see what is causing your sinus infections.

NoThat's not right. You need to follow your doctor's plan of medicine and other treatment for 4 to 6 weeks. This treatment can reduce swelling so your doctor can see what is causing your sinus infections.

I'm not sureIt may help to go back and read "Get the Facts." You need medicine and home treatment for 4 to 6 weeks. This will reduce swelling so your doctor can see what is causing your sinus infections.

3.

Will you probably still have to take medicines and use nasal sprays after surgery?

YesYou're right. You may still have to take antibiotics and use steroid nasal sprays after surgery. They can help you heal and fight infection.

NoSorry, that's not right. You may still have to take antibiotics and use steroid nasal sprays after surgery. They can help you heal and fight infection.

I'm not sureIt may help to go back and read "Get the Facts." You may still have to take antibiotics and use steroid nasal sprays after surgery. They can help you heal and fight infection.

Joint Council of Allergy, Asthma, and Immunology (2005). The diagnosis and management of sinusitis: A practice parameter update. Journal of Allergy and Clinical Immunology, 116(6 Suppl): S13–S47.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Sinusitis: Should I Have Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery to treat long-term (chronic)
sinusitis.

Don't have surgery. Take
medicines and use home treatment.

Key points to remember

Very few people need surgery for sinusitis. Most people can
treat the problem with home care and medicines.

Surgery may be a good choice for people who have long-term
(chronic) sinusitis. They may get one infection after another because something
blocks the flow of mucus from the sinuses or because of another health problem.
Surgery can remove blockages and make the sinus openings bigger. This helps the
sinuses drain, preventing more infections.

To be sure that surgery is a good choice, you need to have a
CT scan of your sinuses. This test will be done after
you have followed what's called "maximum medical treatment" for 4 to 6 weeks.
This means that you take medicines and follow home treatment to reduce
infection and swelling. That helps your doctor see what's causing your
infections.

You may need more than one surgery to fix your sinuses.

After surgery, you still may need to take medicines, such as
antibiotics, and follow home treatment for a long time.

If you
get chronic sinusitis because of
allergies or another problem, you need to get that
problem under control before you have surgery. You will have better results
from surgery if you use medicine and home treatment after surgery to help to
keep that problem under control.

FAQs

What is sinusitis?

When a mucous membrane gets
inflamed, it swells. This can block the normal flow of fluid from the sinuses
into the nose and throat. Bacteria and fungi (plural of fungus) are more likely
to grow and cause an infection in sinuses that can't drain.

The
main cause of sinusitis is a viral infection, usually a cold. Allergies or
other problems also can block the nasal passages and lead to sinusitis.

There are two types of sinusitis: acute (short-term) and chronic
(long-term). You may have chronic sinusitis if:

You have had more than three sinus infections
in 1 year that needed antibiotics to clear up, OR

You have had a sinus infection for more than 12
weeks that
antibiotics have not cleared up.

Surgery may be a good choice for some people who have
chronic sinusitis.

Endoscopic surgery is the type
that is done most often. The doctor puts a thin, lighted tool called an
endoscope in the nose to remove small amounts of bone or tissue that block the
sinus openings. The doctor also can remove polyps.

Traditional surgery may be done
for certain serious problems—such as pus in a sinus, infection of the facial
bones, or a brain
abscess. The doctor makes an opening into the sinus
from inside the mouth or through the skin of the face.

Sometimes another problem inside the nose (such as a
deviated septum ) also needs to be fixed. This may be done during the same
surgery.

After surgery, the doctor may recommend:

Antibiotics to help
fight infection.

Steroid nasal spray to reduce inflammation and help you heal.

Pain medicine.

When is surgery needed for sinusitis?

Very few
people need surgery to treat sinusitis. But you may need surgery if
ALL of these are true:

Your doctor says that you have chronic
sinusitis.

You've followed what's called "maximum medical
treatment" for 4 to 6 weeks. This means that you've taken medicines and
followed home treatment for at least 4 to 6 weeks. This treatment includes
antibiotics, a
steroid nasal spray, and other prescription
medicines.

You've had a
CT scan of your sinuses after the 4 to 6 weeks of
treatment. It is very important to have the CT scan done after this treatment. Reducing the swelling and infection as
much as possible lets your doctor see what could be causing your
infections.

The CT scan shows that something, such as nasal polyps, is keeping your
sinuses from draining as they should.

You also may need surgery if:

You have a sinus infection caused by a
fungus. Infections caused by fungi cannot be cleared up with
antibiotics.

You have a serious problem such as an infection that
spreads beyond your sinuses. This is rare.

What are the benefits of sinus surgery?

Sinus
surgery can:

Help your sinuses drain, which can prevent
sinus infections.

Improve your sense of smell. (But in some cases,
scarring from surgery could decrease your sense of smell.)

Endoscopic surgery improves symptoms
for about 90 out of 100 people. About 10 out of 100 people find that it doesn't
help them.1

Surgery has the best chance
of working if you use a steroid nasal spray and do home treatment after surgery
to prevent future infections. You may need to use these treatments for a long
time.

What can you do for sinusitis other than surgery?

Most of the time, you can treat your sinus problem with home care and
medicines.

Home treatment

Drink plenty of fluids
to help keep the
mucus thin.

Hold a warm, damp towel or a warm gel pack to your face for 5 to 10 minutes several
times a day.

Breathe warm, moist air from a
steamy shower, a hot bath, or a sink filled with hot water. Avoid very cool,
dry air. A humidifier can add moisture to the air in your
home.

Use saltwater nasal drops or washes to help
keep your nasal passages open and to wash out mucus and bacteria. You can buy
saline nose drops or saline nasal washes (such as a Neti Pot) at a drugstore or grocery store, or you can make your
own at home. People around age 8 and older may also find it helpful to gargle often with warm salt water.

If you need to blow your nose, do it gently. Blowing your nose too hard may
force thick mucus back into your sinuses. Keep both nostrils open when you blow
your nose.

Medicines

Take pain relievers, such as
acetaminophen or ibuprofen, that you can buy without a prescription.

Use a steroid nasal spray or decongestant nasal sprays or pills to reduce the swelling of the mucous membranes. If you use a nasal spray, do not use it longer than what the label says.

Take antibiotics as directed, if your doctor prescribes them.
Antibiotics can treat most short-term (acute) sinusitis when it is caused by
bacteria.

Use mucolytics (such as guaifenesin) to thin the mucus in your sinuses.

Be safe with medicines. Read and follow all instructions on the label. Some medicines may not be safe for young children or for people who have certain health problems.

Why might your doctor recommend surgery for sinusitis?

Your doctor might advise you to have surgery if:

You have many sinus infections that need
treatment with antibiotics.

Home treatment doesn't stop your pain
and other symptoms.

You've taken medicines and done home treatment
for 4 to 6 weeks, and tests show that you have a sinus problem that surgery can
fix.

2. Compare your options

Have surgery for
sinusitis

Use home care for
sinusitis

What is usually involved?

You may be asleep. Or the doctor may
numb the area (like at the dentist) and give you medicine to make you
sleepy.

You may have some packing in your nose after surgery. Some types
dissolve on their own. Gauze packing will need to be removed a few days after
surgery.

You still need to take antibiotics and use steroid sprays after
surgery to prevent infection.

You may have to sleep with your head
raised for a few days.

You can't bend forward for a few days after surgery.

You take
antibiotics for a bacterial infection.

You use
steroid nasal sprays,
decongestants, and
over-the-counter pain medicines.

You do
other self-care, such as washing your nasal passages with saline, putting a
warm cloth on your face, and blowing your nose gently.

You don't have
the pain of surgery or need to deal with follow-up care.

You can decide later to have surgery if home care doesn't help
you enough.

What are the risks and side effects?

You may have some pain and
bleeding for 2 weeks after surgery.

You could have less sense of smell after
surgery.

Serious but rare risks can include heavy bleeding,
meningitis, and brain injury. But these happen in less
than 1 out of 100 sinus surgeries. That means they don't happen more than 99 times
out of 100.2

Surgery might not work. About
10 out of 100 people find that it doesn't help.1

You could need to have another surgery.

Home care might not get
rid of your sinus problem.

Antibiotics don't work for viral infections and don't work for all types of bacterial infections.

It won't fix certain serious problems, such as an infection in
the bones of your face or a brain
abscess.

Antibiotics can cause side
effects, which may include
allergic reaction, nausea, and
diarrhea.

Steroid nasal sprays can cause side effects, which may
include a burning feeling in the nose and nosebleeds.

Spray
decongestants can make congestion worse if you use them more times in one day or more days than the label says.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

Personal stories about choosing surgery for sinusitis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have had one sinus infection after another for the better part of a year. I've been taking antibiotics and using steroids and decongestant nasal sprays for a month now with no results. My doctor just did a CT scan and found out that one of my sinuses is blocked. He says he can fix it with surgery."

— Pete, age 43

"I've had a couple of bouts of sinusitis this year, so I asked my doctor about sinus surgery. She said there are some stronger antibiotics and other treatments I should try. I agree that it's better to try the medicines."

— Misti, age 32

"My doctor fired all the medicines at this infection that she could, and I took them just the way she told me to, but nothing seemed to work. After she looked at my CT scan, my doctor thinks what I've got may be a fungal infection. That would explain why the antibiotics I've tried haven't helped. I hate the idea of having the surgery, but I have tried everything else."

— Marona, age 54

"I have pretty bad sinusitis, and I've had it a few times over the years. The last time I got it, my doctor prescribed antibiotics and showed me how to wash out my sinuses with salt water, and that worked. I'm going to try that again, and my doctor says there are some other things we can try, too, like nasal sprays and allergy medicines."

— Jonathan, age 29

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have sinus surgery

Reasons to use home treatment

I want to do everything I can to stop my sinus infections.

I want to avoid surgery if at all possible.

More important

Equally important

More important

I'm not afraid of the risks of surgery.

I don't want to take any chance on problems from surgery.

More important

Equally important

More important

The pain and pressure in my sinuses is making me miserable.

I can control the pain and pressure with medicines.

More important

Equally important

More important

I'm tired of not breathing well.

I can still breathe well.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surgery

Home treatment

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Do most people need surgery to treat sinusitis?

Yes

No

I'm not sure

That's right. Very few people need surgery. Medicines and home care usually are enough.

2.
Do you need to try several weeks of medicines and other treatment before you and you doctor decide about surgery?

Yes

No

I'm not sure

That's right. You need to follow your doctor's plan of medicine and other treatment for 4 to 6 weeks. This treatment can reduce swelling so your doctor can see what is causing your sinus infections.

3.
Will you probably still have to take medicines and use nasal sprays after surgery?

Yes

No

I'm not sure

You're right. You may still have to take antibiotics and use steroid nasal sprays after surgery. They can help you heal and fight infection.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Yes

No

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2.
Check what you need to do before you make this decision.

I'm ready to take action.

I want to discuss the options with others.

I want to learn more about my options.

3.
Use the following space to list questions, concerns, and next steps.

Joint Council of Allergy, Asthma, and Immunology (2005). The diagnosis and management of sinusitis: A practice parameter update. Journal of Allergy and Clinical Immunology, 116(6 Suppl): S13–S47.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Joint Council of Allergy, Asthma, and Immunology (2005). The diagnosis and management of sinusitis: A practice parameter update. Journal of Allergy and Clinical Immunology, 116(6 Suppl): S13–S47.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.
How this information was developed to help you make better health decisions.